Provider Demographics
NPI:1609945500
Name:COTTRELL, MARC
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 N PAULINA ST APT 308
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4597
Mailing Address - Country:US
Mailing Address - Phone:206-335-4127
Mailing Address - Fax:
Practice Address - Street 1:4807 196TH ST SW STE 220
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6409
Practice Address - Country:US
Practice Address - Phone:425-835-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
DCPSY1000981103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00054529OtherREGISTERED COUNSELOR